|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$68,367.52
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$19,750.52 |
| Max. Negotiated Rate |
$68,367.52 |
| Rate for Payer: Aetna Managed Medicare |
$19,750.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53,267.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,828.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,790.11
|
| Rate for Payer: Anthem Medicare Advantage |
$19,750.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,750.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,750.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,750.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,060.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,750.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49,900.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,750.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,750.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,750.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,750.52
|
| Rate for Payer: NAPHCARE Commercial |
$29,625.77
|
| Rate for Payer: Quartz Medicare Advantage |
$19,750.52
|
| Rate for Payer: The Alliance Commercial |
$68,367.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,750.52
|
| Rate for Payer: United Healthcare PPO |
$38,848.54
|
| Rate for Payer: Wellcare Medicare |
$19,750.52
|
|
|
CERVICLE COLLAR PEDIATRIC
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
2963973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.44 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.92
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$195.94
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$212.26
|
| Rate for Payer: Quartz Medicare Advantage |
$195.94
|
| Rate for Payer: The Alliance Commercial |
$163.28
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
CERVICLE COLLAR PEDIATRIC
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
2963973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$195.94
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
CESAREAN SECTION, PRIMARY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
CESAREAN SECTION, PRIMARY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
CESAREAN SECTION, REPEAT
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
CESAREAN SECTION, REPEAT
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$5,085.62
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$4,517.36 |
| Max. Negotiated Rate |
$5,085.62 |
| Rate for Payer: Anthem Medicaid |
$4,869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,869.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,869.76
|
| Rate for Payer: Dean Health Medicaid |
$4,869.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,517.36
|
| Rate for Payer: Managed Health Services Medicaid |
$5,085.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,869.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,869.76
|
| Rate for Payer: United Healthcare Medicaid |
$4,869.76
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$9,820.51
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$8,723.19 |
| Max. Negotiated Rate |
$9,820.51 |
| Rate for Payer: Anthem Medicaid |
$9,403.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,403.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,403.68
|
| Rate for Payer: Dean Health Medicaid |
$9,403.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,723.19
|
| Rate for Payer: Managed Health Services Medicaid |
$9,820.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,403.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,403.68
|
| Rate for Payer: United Healthcare Medicaid |
$9,403.68
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$21,657.73
|
|
|
Service Code
|
APR-DRG 5404
|
| Min. Negotiated Rate |
$19,237.74 |
| Max. Negotiated Rate |
$21,657.73 |
| Rate for Payer: Anthem Medicaid |
$20,738.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,738.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,738.47
|
| Rate for Payer: Dean Health Medicaid |
$20,738.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,237.74
|
| Rate for Payer: Managed Health Services Medicaid |
$21,657.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,738.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,738.47
|
| Rate for Payer: United Healthcare Medicaid |
$20,738.47
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$29,395.60
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$9,059.45 |
| Max. Negotiated Rate |
$29,395.60 |
| Rate for Payer: Aetna Managed Medicare |
$9,059.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$9,059.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,059.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,059.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,059.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,698.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,059.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,316.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,059.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,059.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,059.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,059.45
|
| Rate for Payer: NAPHCARE Commercial |
$13,589.18
|
| Rate for Payer: Quartz Medicare Advantage |
$9,059.45
|
| Rate for Payer: The Alliance Commercial |
$29,395.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,059.45
|
| Rate for Payer: United Healthcare PPO |
$16,595.02
|
| Rate for Payer: Wellcare Medicare |
$9,059.45
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$48,706.32
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$13,138.99 |
| Max. Negotiated Rate |
$48,706.32 |
| Rate for Payer: Aetna Managed Medicare |
$13,138.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$13,138.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,138.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,138.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,138.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,094.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,138.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,479.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,138.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,138.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,138.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,138.99
|
| Rate for Payer: NAPHCARE Commercial |
$19,708.48
|
| Rate for Payer: Quartz Medicare Advantage |
$13,138.99
|
| Rate for Payer: The Alliance Commercial |
$48,706.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,138.99
|
| Rate for Payer: United Healthcare PPO |
$27,621.53
|
| Rate for Payer: Wellcare Medicare |
$13,138.99
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$23,973.04
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$7,849.46 |
| Max. Negotiated Rate |
$23,973.04 |
| Rate for Payer: Aetna Managed Medicare |
$7,849.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,849.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,849.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,849.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,849.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,911.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,849.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,339.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,849.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,849.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,849.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,849.46
|
| Rate for Payer: NAPHCARE Commercial |
$11,774.19
|
| Rate for Payer: Quartz Medicare Advantage |
$7,849.46
|
| Rate for Payer: The Alliance Commercial |
$23,973.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,849.46
|
| Rate for Payer: United Healthcare PPO |
$13,498.95
|
| Rate for Payer: Wellcare Medicare |
$7,849.46
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$6,663.92
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$5,919.31 |
| Max. Negotiated Rate |
$6,663.92 |
| Rate for Payer: Anthem Medicaid |
$6,381.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,381.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,381.07
|
| Rate for Payer: Dean Health Medicaid |
$6,381.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,919.31
|
| Rate for Payer: Managed Health Services Medicaid |
$6,663.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,381.07
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,381.07
|
| Rate for Payer: United Healthcare Medicaid |
$6,381.07
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$5,085.62
|
|
|
Service Code
|
APR-DRG 5391
|
| Min. Negotiated Rate |
$4,517.36 |
| Max. Negotiated Rate |
$5,085.62 |
| Rate for Payer: Anthem Medicaid |
$4,869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,869.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,869.76
|
| Rate for Payer: Dean Health Medicaid |
$4,869.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,517.36
|
| Rate for Payer: Managed Health Services Medicaid |
$5,085.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,869.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,869.76
|
| Rate for Payer: United Healthcare Medicaid |
$4,869.76
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$24,989.68
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$22,197.40 |
| Max. Negotiated Rate |
$24,989.68 |
| Rate for Payer: Anthem Medicaid |
$23,929.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,929.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,929.00
|
| Rate for Payer: Dean Health Medicaid |
$23,929.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22,197.40
|
| Rate for Payer: Managed Health Services Medicaid |
$24,989.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,929.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,929.00
|
| Rate for Payer: United Healthcare Medicaid |
$23,929.00
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$12,977.10
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$11,527.07 |
| Max. Negotiated Rate |
$12,977.10 |
| Rate for Payer: Anthem Medicaid |
$12,426.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,426.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,426.29
|
| Rate for Payer: Dean Health Medicaid |
$12,426.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,527.07
|
| Rate for Payer: Managed Health Services Medicaid |
$12,977.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,426.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,426.29
|
| Rate for Payer: United Healthcare Medicaid |
$12,426.29
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$28,648.88
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$8,625.23 |
| Max. Negotiated Rate |
$28,648.88 |
| Rate for Payer: Aetna Managed Medicare |
$8,625.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$8,625.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,625.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,625.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,625.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,698.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,625.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,768.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,625.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,625.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,625.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,625.23
|
| Rate for Payer: NAPHCARE Commercial |
$12,937.84
|
| Rate for Payer: Quartz Medicare Advantage |
$8,625.23
|
| Rate for Payer: The Alliance Commercial |
$28,648.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,625.23
|
| Rate for Payer: United Healthcare PPO |
$16,168.73
|
| Rate for Payer: Wellcare Medicare |
$8,625.23
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$49,322.00
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$13,619.84 |
| Max. Negotiated Rate |
$49,322.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,308.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$19,308.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,308.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,308.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,308.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,303.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,308.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,932.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,308.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,308.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,308.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,308.41
|
| Rate for Payer: NAPHCARE Commercial |
$28,962.62
|
| Rate for Payer: Quartz Medicare Advantage |
$19,308.41
|
| Rate for Payer: The Alliance Commercial |
$49,322.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,308.41
|
| Rate for Payer: United Healthcare PPO |
$27,973.61
|
| Rate for Payer: Wellcare Medicare |
$19,308.41
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$24,286.08
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$7,841.80 |
| Max. Negotiated Rate |
$24,286.08 |
| Rate for Payer: Aetna Managed Medicare |
$7,841.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,841.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,841.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,841.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,894.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,568.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,841.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,841.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,841.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,841.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,762.70
|
| Rate for Payer: Quartz Medicare Advantage |
$7,841.80
|
| Rate for Payer: The Alliance Commercial |
$24,286.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,841.80
|
| Rate for Payer: United Healthcare PPO |
$13,677.35
|
| Rate for Payer: Wellcare Medicare |
$7,841.80
|
|
|
CF DNA Amplification 83900
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2790818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.99
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF DNA Amplification 83900
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2790818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF DNA Amplification 83900
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2790818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF DNA Amplification 83901
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2848799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
